Standardized medical cognitive assessment tool

ABSTRACT

A testing system and method for evaluation of neurological function are provided. Specifically, the system and method can be used to differentiate between normal and pathological function for motor skills, logic, reasoning, coordination, verbal function, memory, and various other skills. In addition, it is designed to provide a package to a clinician, including a recommended battery of tests and a results report. The system and method described herein is designed to reduce bias due to the human nature of the tester, while still maintaining versatility, individualized attention and depth of analysis in testing.

FIELD AND BACKGROUND OF THE INVENTION

[0001] The present invention relates to a standardized medical cognitiveassessment tool. More specifically, the present invention relates tosystems and methods for testing and evaluating cognitive ability thatare particularly sensitive to mild cognitive impairment and are suitablefor a variety of challenging groups, including the elderly, children,people with learning disorders or short attention spans, the mildlyvisually impaired, and others. The systems and methods described are atool for a clinician to be able to diagnose mental conditions such asAlzheimer's or other forms of dementia, attention deficit disorder, orlearning disorders.

[0002] Cognition is a general term for mental processes by which anindividual acquires knowledge, solves problems, and plans activities.Cognitive skills include attention, visual/spatial perception, judgingand decision-making, problem solving, memory and verbal function, amongothers. The functional levels of each of these skills can be studiedalone or in combination for a particular individual.

[0003] Evaluation and quantification of cognitive ability has been achallenge to both scientists and clinicians. This information isimportant for enabling quick and accurate diagnoses, for directingtreatments, and for tracking the patient's response to medical,surgical, or rehabilitation therapies. Particularly in the clinicalarena, testing systems have been subject to problems of bias, both fromthe external environment and from individuals administering the tests.External biases may include language or culture gaps between the testcontent and the subject taking the test, or lack of familiarity with themechanical aspects of the test, or any other external factor that mayinfluence test taking ability. Potential biases from a testadministrator include conversation between the administrator and thesubject, or subjective observations by the administrator which may playa role in score determination. Furthermore, tests are typicallyadministered without adequate consideration of the skill level of thesubject being tested. The result of this type of oversight may be a testwhich is too easy or too difficult for a particular individual, causing“ceiling” or “floor” effects which essentially eliminate meaningfulresults. This effect is particularly apparent for mildly impairedindividuals, for whom the testing scheme is too complex, either in termsof stimulus and response interfaces, or in terms of the level ofquestions. In addition, traditional tests cannot accurately judgereaction time, which is a factor that should be considered in evaluationof many cognitive skills. Generally, it would be desirable to be able toevaluate several aspects simultaneously and retain the option of scoringbased on each of the skills being tested alone or in combination.

[0004] Most tests that are designed to measure cognitive skill level,such as IQ tests, merely measure function and provide a score. However,current testing systems do not evaluate the borderline region offunctional ability which can indicate a normal versus a pathologicalstate. For example, those with “mild cognitive impairment” whose levelof cognitive function is transitional between normal and dementia areoften not diagnosed in a systematic and reliable way. It would bedesirable to have an objective testing system with specific criteria fordetermining whether intervention would be necessary or helpful.

[0005] Prior art testing systems have been developed to provide aninteractive computerized way of measuring cognitive skills. U.S. Pat.No. 6,435,878 to Reynolds et al. discloses an interactive computerprogram for measuring and analyzing mental ability. Reynolds et al.disclose a system which presents a variety of auditory or visualstimuli, and interactively provides feedback and adjusts the level ofthe test based on received responses. The system tests for reactiontime, memory, attention and decision-making processes. However, it isnot a clinical tool which would be useful for a clinician in providingdiagnostic information related to skill level or pathological state.Prior art systems such as the one disclosed in Reynolds et al. do notsufficiently expand the range of sensitivity and to avoid ceiling orfloor effects in mildly impaired individuals.

[0006] There is thus a widely recognized need for, and it would behighly advantageous to have, a testing system and method devoid of theabove limitations.

SUMMARY OF THE INVENTION

[0007] According to one aspect of the present invention, there isprovided a system for cognitive testing. The system includes a batteryof tests for measuring a neurological parameter, an interface allowing aclinician to access the battery of tests and administer the battery oftests to a subject, the subject generating data in response to theadministered battery of tests, a processor for processing he generateddata, and a report generated by the processor and based on the generateddata, wherein the report is available to the clinician allowing theclinician to diagnose a medical condition and optionally determine atreatment plan.

[0008] According to another aspect of the present invention there isprovided a system for evaluating cognitive function of a subject, thesystem having various levels of testing. The system is particularlyuseful for evaluating a pathological state, such as Alzheimer's diseaseor attention deficit disorder. The system includes an interface forproviding stimuli to and collecting responses from the subject, aprocessor for processing the stimuli and the responses, and a displayfor displaying the scoring information. The processor includes areceiver for receiving the responses and for providing feedback throughthe interface, a calculator for calculating accuracy based on theresponses, a level determinator, for determining an optimal level oftesting based on the calculation, including the option of introducing anew battery of tests, an automatic adjustor, for adjusting the system totest at the determined level, and a scorer for determining scoringinformation based on the responses and the level adjustments.

[0009] According to a further aspect of the present invention, there isprovided a diagnostic tool for determining a pathological state of asubject, the diagnostic tool including a testing system for providingstimuli and receiving responses from the subject, a processor forprocessing the responses into normalized subject indices for selectedcognitive skills, and a database of normal and pathological normalizedindices collected from selected populations, wherein the normalizedsubject indices are compared to the normal and pathological normalizedindices so as to determine the pathological state of the subject.

[0010] According to yet a further aspect of the present invention, thereis provided a computer-based testing system, the system including astimulus for evoking a response from a tested subject, the stimulusbeing relatively large so as to enable a mildly visually impairedindividual to see the stimulus, and an interface for responding to thestimulus, the interface requiring minimal mental, visual, and motorability.

[0011] According to a further aspect of the present invention, there isprovided a method for cognitive testing, the method including retrievinga battery of tests through an interface, administering the battery oftests to a subject, collecting data from the subject in response to thebattery of tests, processing the collected data so as to generate areport, accessing the report, and providing a diagnosis based on thereport.

[0012] According to a further aspect of the present invention, there isprovided a method for evaluating a cognitive skill of a subject, themethod including familiarizing the subject with a testing system,providing dynamically adjustable stimuli from the testing system to thesubject, receiving responses to the stimuli, and evaluating theresponses. The step of familiarizing includes providing a stimulus tothe subject, receiving a response to the stimulus from the subject,determining accuracy of the response, and providing information aboutthe accuracy to the subject.

[0013] According to another aspect of the present invention, there isprovided a method for distinguishing between normal and pathologicalaging, the method including providing a battery of tests whereinresponses to stimuli are collected, compiling an index score based onthe collected responses, and comparing the index score to a performancedatabase.

[0014] According to yet a further aspect of the present invention, thereis provided a method for providing a diagnostic report to a clinician,the method including obtaining an index score for a cognitive skill,graphing the index score in relation to a database of index scores froma population, graphing the index score in relation to previouslyobtained index scores from the subject, and presenting the graphed indexscores in a report format to the clinician.

[0015] Unless otherwise defined, all technical and scientific terms usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which this invention belongs. Although methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present invention, suitable methods andmaterials are described below. In case of conflict, the patentspecification, including definitions, will control. In addition, thematerials, methods, and examples are illustrative only and not intendedto be limiting.

[0016] Implementation of the method and system of the present inventioninvolves performing or completing selected tasks or steps manually,automatically, or a combination thereof. Moreover, according to actualinstrumentation and equipment of preferred embodiments of the method andsystem of the present invention, several selected steps could beimplemented by hardware or by software on any operating system of anyfirmware or a combination thereof. For example, as hardware, selectedsteps of the invention could be implemented as a chip or a circuit. Assoftware, selected steps of the invention could be implemented as aplurality of software instructions being executed by a computer usingany suitable operating system. In any case, selected steps of the methodand system of the invention could be described as being performed by adata processor, such as a computing platform for executing a pluralityof instructions.

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin the cause of providing what is believed to be the most useful andreadily understood description of the principles and conceptual aspectsof the invention. In this regard, no attempt is made to show structuraldetails of the invention in more detail than is necessary for afundamental understanding of the invention, the description taken withthe drawings making apparent to those skilled in the art how the severalforms of the invention may be embodied in practice.

[0018] In the drawings:

[0019]FIG. 1 is a diagrammatic overview of the basic elements of themethod and system of the present invention according to one preferredembodiment;

[0020]FIG. 2 is a block diagram illustration of a testing systemaccording to a preferred embodiment of the present invention;

[0021]FIG. 3 is a flow diagram of the steps of a finger tap testaccording to one embodiment of the present invention;

[0022]FIG. 4 is a flow diagram of the steps of a test according to oneembodiment of the present invention;

[0023]FIG. 5 is a sample screen shot of a catch test according to oneembodiment of the present invention;

[0024]FIG. 6 is a sample three-dimensional picture shown in a 3-Dspatial orientation test, in accordance with one embodiment of thepresent invention;

[0025]FIG. 7 is a screen shot of images shown in the preparatory phaseof a non-verbal memory test;

[0026]FIG. 8 is a screen shot of images shown in the quiz phase of thenon-verbal memory test of FIG. 7; and

[0027]FIG. 9 is a screen shot of images shown in a non-verbal IQ test.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0028] The present invention is of a testing system and method forevaluation of neurological function. Specifically, the present inventioncan be used to differentiate between normal and pathological functionfor motor skills, logic, reasoning, coordination, verbal function,memory, and various other skills. In addition, it is designed to providea package to a clinician, including a recommended battery of tests and aresults report. The system and method described herein is designed toreduce bias due to the human nature of the tester, while stillmaintaining versatility, individualized attention and depth of analysisin testing.

[0029] The system and method of the present invention can be used acrossa wide range of performance levels—from normal individuals to those withextreme mental disabilities. There is a very wide range of tests, andvarious decision points, allowing a practitioner to closely monitor theperformance of an individual, both at the time of the test and duringfollow up testing sessions. All of this can be done with relative easedue to the fact that the practitioner is provided with means fordeciding what tests to administer and detailed, clear reports followingeach testing session. It is designed to be a practical, inexpensivemedical tool that could be employed in the physician's office, intesting centers, or in the field and would provide reports in real time.

[0030] Before explaining at least one embodiment of the invention indetail, it is to be understood that the invention is not limited in itsapplication to the details of construction and the arrangement of thecomponents set forth in the following description or illustrated in thedrawings. The general principles of the present invention will bedescribed with reference to several embodiments, with specific detailsof several tests described fully. However, the invention is capable ofother embodiments or of being practiced or carried out in various wayswith many alternatives, modifications and variations, and many othertests may fall within the realm of the present invention. Accordingly,it is intended to embrace all such alternatives, modifications andvariations that fall within the spirit and broad scope of the appendedclaims. Also, it is to be understood that the phraseology andterminology employed herein is for the purpose of description and shouldnot be regarded as limiting.

[0031] It is appreciated that certain features of the invention, whichare, for clarity, described in the context of separate embodiments, mayalso be provided in combination in a single embodiment. Conversely,various features of the invention, which are, for brevity, described inthe context of a single embodiment, may also be provided separately orin any suitable subcombination.

[0032] The principles and operation of a testing system and methodaccording to the present invention may be better understood withreference to the drawings and accompanying descriptions.

[0033] Reference is now made to FIG. 1, which depicts a diagrammaticoverview of the basic elements of the method and system of the presentinvention. As shown in FIG. 1, the basic elements revolve around aclinician 30 who is qualified to administer psychological tests andprovide or direct a subject to appropriate medical care based on resultsof the test. The clinician 30 may be a physician, psychologist,neuropsychologist, social worker, or any other person who would performa psychological or medical evaluation on an individual. The inventiondescribed herein is a system and method which provides the clinician 30with the necessary tools for choosing and administering appropriatetests tailored for individual needs, as well as tools for receiving andinterpreting the results of the administered tests. Thus, both aspecialized battery of tests 32 and an assessment report 34 are providedto the clinician 30, before and after test administration, respectively.The specialized battery of tests 32 is compiled based on several factorsincluding detailed patient information 36, and information about thecognitive skills 38 to be measured. Patient information 36 may includemedical condition, age, presumed level of cognition, familiarity withthe testing medium, and any other potentially relevant characteristics.Cognitive skills 38 may be very specific, such as memory, attention, orsome other single characteristic, or may include a combination ofseveral skills. Once the specialized battery of tests 32 is compiled, itis sent to the clinician 30, who then administers the battery of tests32 to a subject. The test results 40 are used to adjust the test itselfwhile it is being administered. At the end of the testing session, thetest results are compiled into an assessment report 34, which is easy toread and interpret.

[0034] The specialized battery of tests 32 is compiled based on patientinformation and information about which cognitive skills the clinicianis interested in. Prior art systems have included testing some of theseskills alone, or at most in linear combination with one or two otherskills. The present invention allows for an expansion of the testing inorder to provide a more complete picture of the subject's abilities andlevels of performance. Thus, if the purpose of the testing session is toevaluate memory, a battery of memory tests will be provided, each one ofwhich will test a different type of memory. If the purpose of thetesting session is to evaluate general cognitive function, severaldifferent cognitive skills will be tested, such as memory, executivefunction, visual/spatial orientation, verbal function, attention,information processing, or any other cognitive skill which may beconsidered relevant. It should be readily apparent that any combinationof tests may form a battery for various different evaluation purposes.

[0035] According to one embodiment, the clinician is provided with atesting wizard, which asks the clinician for specific details about thepatient and the purpose of the test. The wizard then helps to determinethe appropriate battery of tests based on the information provided bythe clinician. According to an alternative embodiment, the clinician isprovided with a list of battery names and a brief description of eachone. In any case, the clinician is assisted in choosing an appropriatebattery of tests. Additional details may be considered, including theorder in which the different tests are administered, or the skill levelat which the tests should be performed.

[0036] The decision-making tools used by the system to determineappropriate batteries of tests are based on published knowledge in thefield of neuropsychology, and are taken from well-known sources, suchas, for example, Spreen O & Strauss E: A Compendium ofneuropsychological tests: Administration, norms, and commentary, NY:Oxford University Press (1991), Snyder, P. J. & Nussbaum, P. D. (Eds)Clinical Neuropsychology; and A Pocket Handbook for Assessment, AmericanPsychological Association (1998). That is, an automated service providesa usable accumulation of knowledge gleaned from experts in the field,based on individualized parameters, similar to a consultation by aneuropsychologist.

[0037] An example of a chosen battery is a person displaying memoryloss. If a physician wants to determine whether the memory loss is dueto normal aging or might be due to the onset of a pathologicalcondition, such as Alzheimer's, he would choose the mild cognitiveimpairment (MCI) scale, which focuses on issues that are important forthat particular determination, such as memory and executive function.Another example would be a person with a mild head injury who isdisplaying poor concentration at work. In that particular case, aphysician might choose a battery of tests including evaluation ofattention, concentration, and short-term memory.

[0038] The tests themselves are designed to provide more information andmore accurate information than prior art testing systems, whilemaintaining a distance from the test administrator so as to reduce humanbias. Several unique concepts and features are present in many or all ofthe tests of the present invention. Some of these unique features aredescribed hereinbelow. It should be noted that the discussion whichfollows is not intended to be presented in any particular order, and nosignificance should be placed on the order or the categorization offeatures discussed herein.

I. Subject/System Interface

[0039] All of the tests are designed with a simple and intuitiveinterface. Embodiments of the interface may include a computer monitoror other type of display in communication with a mouse, joystick,keyboard, number pad, touch screen, voice recognition system, or anyother interface designed to provide communication between a user and atesting system. The use of this type of interface helps to eliminate anypotential bias which may have been introduced based on unfamiliaritywith the system or difficulty in executing the answers.

[0040] Additionally, although the instructions and interface areuser-friendly, even for those with little or no previous experience, anoptional orientation session is also provided, wherein very basic stepsneeded for performing the test are reviewed or taught. For example, ifthe test is given on a standard computer with a mouse and keypad, thebasic features of the mouse and keypad are presented in an interactivemanner so that the subject will not be limited in his/her performance bylack of previous experience. The orientation session may be particularlyuseful in testing the elderly, who may not be familiar with moderntechnological advances.

II. Practice Sessions

[0041] Once it is ascertained that the subject is familiar enough withthe testing system to proceed without difficulty, it is then necessaryto evaluate whether the test or battery of tests are appropriate for theindividual. Built into each test is at least one practice session, whichis used to determine several important facts. First, the practicesession is used to evaluate the suitability of a test for a particularindividual before beginning the scoring process. Generally, the subjectis given certain simple instructions, and is provided with feedback sothat he/she can learn the nature of the test, either with regard to thequestions being asked or with regard to the mechanical performance ofanswering the questions, or with regard to any other basic element ofthe test. If a subject is not able to pass the practice portion of thetest (according to predetermined criteria, such as accuracy), it ispossible that the subject's cognitive ability falls outside of the rangeof suitability for the particular test and as such, the test isterminated and another test may be chosen.

[0042] Second, even for those individuals who do understand the basicinstructions, there is often an initial learning period, which, if notaccounted for, can skew the final scored results. By providing apractice session before each test, the learning period is primarilyovercome during this time, wherein the subject is allowed to practicewhile being given feedback about his/her performance. In this way, theresults can be expected to reflect the subject matter being tested,rather than a lack of familiarity with the test itself or other factors.Additionally, the level of the test can be adjusted to suit the subjectbased on the results of the practice session, as will be described infurther detail hereinbelow with regard to the adaptive nature of thetests.

[0043] Finally, the practice session provides for a structured periodwhere a test supervisor can interact with the subject to make sureeverything is clear. Thus, the supervisor is able to completely avoidinteraction with the subject during the actual test, thereby eliminatinga further potential bias in the test results.

III. Adaptive Nature

[0044] Responses are dynamically analyzed on an ongoing basis bothduring the practice session and during the test itself. Thus, the levelof difficulty can be adjusted to suit the particular individual. This“dynamic floor/ceiling” feature allows for the testing to be done at anappropriate level for each individual, or alternatively, to beterminated if the subject's performance is below a certain predeterminedthreshold, thereby providing more accurate results and datainterpretation. The adaptive nature of the tests serves to eliminatestatic “ceiling” or “floor” effects. That is, the subject is challengedaccording to his/her level and the level can be adjusted throughout soas to provide an optimal level of testing. This feature is also a usefultool for determination of a normal versus pathological level offunction. By honing in on the most appropriate level of testing, it ispossible for people to be tested within their functional category,rather than by comparing normal function to pathological function. Also,by grouping results from normal and pathological individuals, it ispossible to obtain specific testing criteria for each of these groups.It should be noted that although specific levels of testing aredescribed below with reference to each test, these levels are merelyexamples used to illustrate the concept of having several levels oftesting within one testing session. A larger or smaller number oflevels, as well as various types of levels based on speed, difficulty,or other criteria, are possible.

IV. Stimulus

[0045] The type of stimulus used for each particular test is designed soas to be most conducive to producing a response, without distractions orconfusing information. Thus, the stimulus is designed in each case to bea simple indication of the task to be performed. Any confoundingfactors, such as extraneous visual information, are eliminated.Additionally, factors which may interfere with the subject's ability tounderstand or read the stimulus are avoided, such as language barriers,or letters which are too small.

[0046] Additionally, the choice of specific stimuli is made based on anassessment of appropriateness for individual tests. For example, testsinvolving scenes are not highly detailed, are realistic and areculturally independent. Alternatively, in tests in which the angle of astimulus is important, the angle is chosen appropriately for theindividual skill being tested. Generally, stimuli are chosen to mostclearly isolate the skill being tested, without introducing extraneouscomplexities. Furthermore, the levels of complexity are predefined andare closely related to the choices of stimuli. Thus, what is presentedon the monitor is designed to elicit relevant responses appropriate forthe goals of each test. The general idea is to choose stimuli whichmeasure the particular function, while minimizing all other influences.The limits of complexity and the choice of particular stimuli are basedon published as well as tested psychological data for testing criteria.References for published data include, among others, Lu C H, Proctor RW: Influence of irrelevant information on human performance: effects ofS-R association strength and relative timing in Quarterly Journal ofExperimental Psychology, 54(1):95-136, and La Heij W, van der Heijden AH, and Plooij P: A paradoxical exposure-duration effect in the Strooptask: temporal segregation between stimulus attributes facilitatesselection in Journal of Experimental Psychology: Human Perception andPerformance, 27(3):622-32.

V. Ouality Control

[0047] Certain features are incorporated into the system and intospecific tests to ensure that the data are valid and that they are anaccurate measure of the specific feature.

[0048] One important aspect of many of the tests is response time. Inorder to ensure accuracy of the timing mechanism within eachindividual's system, a built-in measurement mechanism is set to checkthe motherboard, thus revealing any potential discrepancies between themeasured time and the actual time. This provides for accuracy in the1-10 millisecond range, which is at least an order of magnitude moreaccurate than a typical Windows based program, for example. Results maythen be adjusted to account for any discrepancies. In this way, anindividual system which has little memory and thus is inefficient willnot interfere with the results interpretation.

[0049] In addition to the above-mentioned quality control measures,final results are processed either on-line or off-line and are checkedfor missing data, and compared to an expected range of values to makesure that data analysis has been performed properly.

[0050] Reference is now made to FIG. 2, which is a block diagramillustration of a testing system 10 according to a preferred embodimentof the present invention. A subject 11 being tested is in communicationwith testing system 10 via an interface 12. Interface 12 is configuredto accept data collected by responses of subject 11 to stimuli providedby testing system 10. Interface 12 communicates with system 10 via aprocessor 14, configured to accept and analyze the data, providefeedback to user 11, adjust the testing scheme, and send results.Processor 14 has a receiver 16 for receiving data, a calculator 18 forcalculating performance, a level determinator 20, for determining askill level of subject 11, an adjustor 22 for adjusting the level oftesting, and a scorer 24 for determining a score based on the receiveddata. The processor sends the processed score information to a display26. Display 26 may be an audio or visual display, and is either directlyor remotely connected to the rest of system 10.

[0051] Initially, a stimulus is presented to subject 11, who thenresponds to the stimulus. Both the presentation of the stimulus and theresponse thereto are directed through interface 12. In a preferredembodiment, interface 12 is a computer system having an input such as amouse, keypad, joystick or any other input device, and a display forpresentation of the stimulus. It should be readily apparent that anysystem useful for presentation of a stimulus and collection of responsesmay be used. However, it is preferable that interface 12 be intuitiveand simple to understand. If necessary, an orientation session isprovided so as to familiarize subject 11 with interface 12, therebyeliminating the possibility of bias due to lack of familiarity with thetechnology.

[0052] Receiver 16 collects responses from subject 11 through interface12, and sends the data to a calculator 18. Calculator 18 calculatesperformance factors, such as accuracy, speed, etc., as will be describedin further detail hereinbelow. General performance is rated based oncertain predefined criteria, such as threshold levels, percentage ofaccurate responses, or any other criterion deemed to be relevant.Calculator 18 sends performance data to level determinator 20 and toscorer 24. Level determinator 20 determines an appropriate level oftesting based on the performance data, and sends the data to bothadjustor 22 and to scorer 24. Adjustor 22 adjusts the level of testing,which is directed through interface 12 to subject 11 for additionaltesting. In many instances, the determined level is also useful incalculating a final score. Scorer 24 uses data from level determinator20 and from calculator 18 to determine a score. The score may be in theform of a number, a series of numbers, a chart or a graph or any otherformat. The score is sent to display 26 either via direct or remoteconnection, which then displays the score in an easily readable format.

[0053] It should be noted that level determinator 20 is helpful indetermining both a level of testing for normal subjects, and whether thespecific battery of tests is appropriate for subjects in a debilitatedor diseased state. If it is determined that the specific tests beingused are not appropriate for an individual, other tests with simplifiedstimuli and choices are used instead.

[0054] Examples of several specific tests are described herein. Forclarity, the tests have been divided into categories relating todifferent cognitive functions. However, in many cases the tests overlapmore than one category, as some of the tests are multifunctional in datacollection and interpretation. The categories used herein are thefollowing: motor skills, visual/spatial perception, memory, informationprocessing, verbal function, and executive function. It should bereadily apparent that although each test has specific unique features,many common features are shared between some or all of the tests, andeach test described can be altered to serve various purposes. Thepurpose of the tests is both to evaluate an individual's ability as wellas to help define parameters within which pathology can be defined.

[0055] A) MOTOR SKILLS:

[0056] Finger Tap Test

[0057]FIG. 3 depicts a flow diagram of the steps of a finger tap test100 according to one embodiment of the present invention. The purpose ofthis test is to assess speed of tapping, and regularity of fingermovement.

[0058] At the beginning of the test, the system displays (step 101)instructions. The instructions describe what the subject will see on thescreen, and instruct him/her what to do when the stimulus appears. Themessage may be very detailed, specifying, for example, which hand touse. The subject is asked to tap in response to a specific stimulus.Initially, the system runs a practice session (step 102), in which avery basic form of the test is given, along with feedback informing thesubject whether or not the test is being done properly. The subject isgiven several chances to perform the requested task, and if the initialscore is below a certain predetermined level, the test is terminated. Ina preferred embodiment, the scoring is designed to elucidate whether ornot tapping was detected. If it was detected a certain percentage oftime, the test continues.

[0059] The main testing portion begins by displaying (step 103) astimulus for a predetermined amount of time. In a preferred embodiment,the stimulus is a bar or line on the screen which increases in lengthwith time. In alternative embodiments, the stimulus is a shape whichmoves across the screen, or is any other form and movement which isdisplayed for a predetermined amount of time. In one embodiment, thepredetermined amount of time is 10-15 seconds. In a preferredembodiment, the stimulus is displayed for 12 seconds. It should bereadily apparent that the stimulus may be displayed for any length oftime which may be useful in testing the response. The subject isexpected to repeatedly tap as quickly as possible in response to thestimulus, as explained in the instructions or by a test administratorprior to commencement of the testing portion. In a preferred embodiment,tapping is done on one of the mouse buttons. Alternative embodimentsinclude tapping on a finger pad, a keypad, or any other button or objectconfigured to receive proprioceptive information and convey theinformation to a processor.

[0060] If tapping is detected, data is collected during the time ittakes for the stimulus to move across the screen, or until some otherindication is made to stop. If tapping is not detected, the systemdisplays (step 104) an error message, after which the stimulus isdisplayed again. The error message may be a reminder of how to respond.If tapping is detected, the test continues until the predeterminedamount of time has elapsed. Once the time has elapsed, the test ends.

[0061] Detection of tapping is determined by specific criteria. Fortesting purposes, tapping is considered to not have occurred if theinter-tap interval, or ITI, is greater than a predetermined amount. In apreferred embodiment, the maximum ITI is 500 ms, but it should bereadily apparent that any time span may be chosen.

[0062] Once the testing sequence is completed, outcome is determinedbased on several parameters, including the times at which the test beganand at which the response was received, the overall mean and standarddeviation of ITI for right hand and for left hand, and the number oftaps per session.

[0063] Reference is made to FIG. 4, which depicts a general flow diagramrepresentation of tests that have more than one level. Thus, thedescriptions of the tests that follow will be more easily understood inconjunction with FIG. 4.

Catch Test

[0064] Reference is made to FIGS. 4 and 5, which depict a flow diagramof the steps of a test 200, and a sample screen shot of a catch test insession, according to one embodiment of the present invention. Thepurpose of this test is to assess hand/eye coordination, speed ofmovement, motor planning and spatial perception. The subject is asked tocatch a first object 30 falling from the top of a screen using a secondobject 32 on the bottom of the screen, as shown in FIG. 5 and describedin further detail hereinbelow. An important aspect of this test is thatits simplicity allows for a very short learning curve, therebyminimizing effects of prior computer use on test performance. That is, aperson with little or no experience is able to perform comparably with aperson with a great deal of computer experience within a very shorttime, thereby allowing for isolation of the particular skills to betested.

[0065] First, the system displays (step 201) a set of instructions. Theinstructions direct the subject to catch the falling object with amovable object on the bottom of the screen. In a preferred embodiment,the falling object 30 is a simple shape and color, such as a greensquare or a blue ball. In a preferred embodiment, the movable object 32is a straight line or some other simple shape that might represent apaddle or racquet, such as the shape depicted in FIG. 5. It should bereadily apparent that any suitable shape may be used. In a preferredembodiment, movable object 32 is a long rectangular shape of 10-20mm×1-5 mm. In an exemplary preferred embodiment, movable object 32 is15×2 mm. In the instructions, the subject is directed as to how to moveobject 32 from side to side. Any button may be configured to allowobject 32 to move in a controlled manner. In a preferred embodiment, theright mouse button may be used to move object 32 to the right and theleft mouse button to move object 32 to the left, or arrow buttons on akeyboard may be used. In a preferred embodiment, each mouse click movesthe object one length, and the object cannot leave the bounds of thescreen. However, it should be readily apparent that the controlmechanism is not limited to those listed herein, and any suitablecontrol mechanism may be used.

[0066] The test begins by providing (step 202) a practice session. Inthe practice session, the subject is expected to catch a falling object.If the subject catches the object, the system displays a positivefeedback message. If the subject does not catch the element, the systemdisplays a feedback message explaining that the objective is to catchthe object falling from the top of the screen, and further explaininghow to move the object. Once a predetermined number of trials aresuccessfully completed, the test moves on to the next level. Successfulcompletion of the practice session is determined by a percentage ofsuccessful catching of the object. In a preferred embodiment, thesubject must catch the object at least 2 out of 3 times in order for thetesting session to continue.

[0067] If the practice-session is passed, the test continues bydisplaying (step 203) the falling object 30 at a predetermined speed andcalculating the number of successful catches. If the catching score ishigher than a predetermined level, the test continues by moving onto thenext level, at which object 30 is configured to fall at a faster speed.If the catching score is lower than the predetermined level, the testingsession is terminated.

[0068] In a preferred embodiment, in the first level of testing it takesbetween 3000 and 5000 ms for object 30 to reach the bottom of thescreen. In an exemplary preferred embodiment, in the first level oftesting it takes 4000 ms for object 30 to reach the bottom of thescreen. Subsequent levels each have a faster falling rate than theprevious level. Thus, in a preferred embodiment, at the second level oftesting it takes 3000 ms for the element to fall, at the third level ittakes 2000 ms and at the fourth level it takes 1000 ms. It should bereadily apparent that any time interval may be used, as long as eachlevel has a faster rate than the previous one. In addition, any numberof levels may be used, until the subject reaches a point at which thetest is too difficult.

[0069] The starting position of both the falling object 30 and themovable object 32 in relation to the falling element vary from trial totrial. In addition, the path of falling object 30 is also variable, andmay be useful in increasing the difficulty of the test. For all levels,if the subject performs a successful catch a predetermined number oftimes, the test moves on to the next level. Otherwise, the test isterminated.

[0070] The system collects data related to the responses, includingtiming, initial location of element and object, number of errors, numberof moves to the left and to the right, and level of testing, andpresents a score or multiple scores based on the above parameters.

[0071] B) VISUAL/SPATIAL PERCEPTION:

[0072] 3-D Spatial Orientation Test

[0073] A 3-D spatial orientation test is provided, according to oneembodiment of the present invention. The purpose of this test is toassess spatial perception and mental rotation capabilities. FIG. 6depicts a sample three-dimensional picture shown in the 3-D spatialorientation test.

[0074] At the beginning of each test, a three-dimensional picture suchas the one shown in FIG. 6 appears on a screen with a marker 34 locatedin variable places on the picture. The marker 34 is of a specified shapeor color, for example, a blue line, a green diamond, a red pillar or anyother suitable form. A set of pictures is shown on another part of thescreen. Each of the pictures represents a potential view of the pictureas seen from the position of marker 34. The subject is expected tochoose the most correct view, based on the pictures shown on the screen.Neither the picture nor the marker is limited to the ones described andshown herein, but rather, may be any three-dimensional orientation ofobjects suitable for testing spatial orientation. It should be noted,however, that the choice of scene is predetermined based on simplicityand least likelihood of causing interference with the actual skillsbeing tested.

[0075] The test may include several levels and as such, the basic formatis shown FIG. 4. First, the system displays (step 201) a set ofinstructions. The instructions direct the subject to imagine standing atthe place of the marker 34, and to visualize what view of thethree-dimensional picture would be seen from that position. In apreferred embodiment, an example is displayed, followed by the correctanswer for further edification. The instructions end with an explanationof how to choose the correct answer, for example, by pressing thecorrect number on the number pad of a keyboard.

[0076] The test begins (step 202) with a practice session. During thepractice session, the choices remain on the screen until one of thedisplayed pictures is selected as a response, and once a selection ismade, positive or negative feedback is provided to the subject. For thepractice session, the marker is placed directly in front of the scene orin some other similarly easy to visualize location. Once a predeterminednumber of trials are successfully completed, the regular testing sessionis administered. A determination of whether or not the practice sessionwas successfully completed is made based on the number of correctresponses. In one embodiment, if two answers are sequentially correct,the test practice session has been completed successfully. If not, twoadditional pictures are shown. If the overall accuracy is two out offour correct or less, the test is terminated. Otherwise, the test moveson to the next level. It should be readily apparent that the requirednumber of correct responses can be varied.

[0077] Once the practice session is completed, the testing round begins.The system displays (step 203) a picture similar to the one displayed inthe practice session. In a preferred embodiment, the marker 34 is placedin a slightly more difficult location, such as on one side or at varyingdistances. In one embodiment, a sample size of at least 10-20 picturesis collected. For all levels of the testing round, no feedback is givento the subject. The accuracy is then calculated. If the performance isacceptable based on predetermined criteria, the testing session moves(step 204) onto the next level. Otherwise, the test is terminated. Inone embodiment, an acceptable criterion is at least 70% accuracy.

[0078] A higher level tests relative spatial perception. A first pictureis shown on one part of a screen, and four choices are shown on adifferent part of the screen, as in the other levels. However, althoughall four of the choices show pictures similar to the first one atvarious angles, only one of the four options actually has the sameelements in the same relative locations. Thus, the subject is requiredto determine not only what the approximate view would be from themarker, but also which view is an accurate depiction of the originalscene at a different angle. It should be readily apparent that anynumber of levels of increasing difficulty may be used.

[0079] The system collects data related to the responses, includingtiming, correctness and level of testing, and presents a score based onthe above parameters.

[0080] C) MEMORY:

[0081] Verbal Memory Test

[0082] A verbal memory test is provided, whose purpose is to evaluate asubject's ability to remember pairs of words that are not necessarilyassociated with one another. Reference is again made to FIG. 4, which isa flow chart depiction of the basic steps of a test in accordance withan embodiment of the present invention. At the beginning of the test,the system displays (step 201) a set of instructions explaining thathe/she will be shown pairs of words to remember, and that at least someof the words do not normally go together.

[0083] The test begins (step 202) with a practice session. Within thepractice session as well as the testing sessions described below, thereare two portions to the test. The first part of the test is thepreparatory phase, in which the system displays a specified number ofword pairs for a particular amount of time, with a pause in between eachdisplay. In a preferred embodiment, the practice session includes threeword pairs, each of which is displayed on the screen for 2500 ms with a200 ms pause in between. The second part of the test is the quiz phase,in which the system displays the first word of the first pair, and fourchoices, one of which is the second word of the first pair. The otherthree are decoys, some of which are specifically related to one of thewords of the pair. The screen remains visible until there is a response.This is repeated for the second word pair and again for the third, untilthe total number of word pairs has been tested. During the practicesession, the system provides positive and negative feedback to thesubject after each response. If the subject passes a predeterminedthreshold (such as ⅔ correct, for example), the test moves on to thenext level. Otherwise, it repeats the practice level one time, and ifthe threshold is still not reached, the test is terminated.

[0084] At the testing level, word pairs are displayed (step 203). Morepairs of words are shown than in the practice session, and no feedbackis given. A specified number of word pairs are shown, and if theresponses are not 100% correct, the test is repeated by showing all ofthe word pairs again and asking the subject to choose the correctresponse. Repetitions can occur up to a specified number of times. In apreferred embodiment, repetitions may occur up to six times. If theaccuracy is less than, for example, 30% on two subsequent repetitions,the test is terminated. If the accuracy is higher than that amount, thetest moves on to the next level. Higher levels may include moredifficult pairs, more pairs, and shorter intervals.

[0085] In order to study delayed recognition, this test may be retrievedat a later time within the battery of tests in order to see whether thesubject remembers the pairs that were shown at the beginning. Forexample, this test may be given, then the subject will be tested onmotor skills or some other testing scheme, and then this test willreturn, without showing the individual the original word pairs again.Certain factors may be relevant, including the sequence of tests and thetime interval between when the original pairs were shown and when thesubject is asked to retrieve it again from his/her memory.

[0086] The system collects data related to the responses, including thenumber of repetitions, the level, the accuracy and correctness of theresponses, and determines a score based on these parameters.

[0087] Non-Verbal Memory Test

[0088] There is provided, in accordance with another embodiment of thepresent invention, a non-verbal memory test. The purpose of the test isto evaluate a subject's ability to remember the spatial orientation of apicture. Thus, this test is a spatial perception test as well as one ofmemory. At the beginning of the test, the system presents (step 201) aset of instructions. The test begins (step 202) with a practice session.The first part of the test is the preparatory phase, in which the systemdisplays a specified number of images, one at a time for a particularamount of time, with a pause in between each display. In a preferredembodiment, the practice session includes one image, which is displayedon the screen for 5 seconds. The second part of the test is the quizphase, in which the system displays four choices, one of which is theimage that was shown 20 seconds earlier. The other three are decoys,some of which are specifically related to the image or its orientation.The screen remains visible until there is a response. During thepractice session, the system provides positive and negative feedback tothe subject after each response. If the subject passes a predeterminedthreshold (such as ⅔ correct), the test moves on to the next level.Otherwise, it repeats the practice level one time, and if the thresholdis still not reached, the test is terminated.

[0089] Reference is now made to FIGS. 7 and 8, which are examples ofscreen shots of images shown in the preparatory phase and the quiz phaseof the test. It should be readily apparent that the images are notlimited to the ones shown herein, but rather, any suitable images may beused. As shown in FIG. 7, during the preparatory phase, several imagesare shown together for 20 seconds. During the quiz phase, one of theimages from the screen shot of FIG. 7 is shown in several possibleorientations, such as is depicted in FIG. 8. The subject is asked tochoose the correct orientation. In a preferred embodiment, eight imagesare shown in the preparatory phase, and if the responses are not 100%correct, the test is repeated. Repetitions can occur up to apredetermined number of times, preferably six. If the accuracy is lessthan a predetermined amount on two subsequent repetitions, the test isterminated. In a preferred embodiment, the predetermined amount is 30%.A delayed memory test may be performed later within the testing seriesto see whether the individual remembers the orientations shownpreviously, similarly to the delayed pair verbal test described above.

[0090] D) INFORMATION PROCESSING:

[0091] Staged Math Test

[0092] A staged math test is provided in accordance with one embodimentof the present invention. The purpose of the test is to evaluate asubject's ability to process information, testing both reaction time andaccuracy. Additionally, this test evaluates math ability, attention, andmental flexibility, while controlling for motor ability.

[0093] In a preferred embodiment, the test consists of at least threebasic levels of difficulty, each of which is subdivided into subsectionlevels of speed. The test begins with a display of instructions (step201) and a practice session (step 202). The first subsection level ofthe first level is a practice session, to familiarize the subject withthe appropriate buttons to press when a particular number is given. Forexample, the subject is told that if the number is 4 or less, he/sheshould press the left mouse button. If the number is higher than 4,he/she should press the right mouse button. The instructions continuewith more detailed explanation, explaining that if the number is 4, thesubject should press the left mouse button and if the number is 5, thesubject should press the right mouse button. It should be readilyapparent that any number can be used, and as such, the descriptionherein is by way of example only.

[0094] A number is then shown on the screen. If the subject presses thecorrect mouse button, the system responds positively to let the userknow that the correct method is being used. If the user presses anincorrect mouse button, the system provides feedback explaining therules again. This level continues for a predetermined number of trials(5 in a preferred embodiment), after which the system evaluatesperformance. If, for example, 4 out of 5 answers are correct, the systemmoves on to the next level. If less than that number is correct, thepractice level is repeated, and then reevaluated. If after two practicesessions the performance level is still less than 80%, the test isterminated.

[0095] The test is then performed at various levels, in which a stimulusis displayed (step 203), responses are evaluated, and the test is eitherterminated or the level is increased (step 204). The next threesubsection levels perform the same quiz as the trial session, but atincreasing speeds and without feedback to the subject. The speed oftesting is increased as the levels increase by decreasing the length oftime that the stimulus is provided. Thus, in a preferred embodiment, thefirst set of stimuli are provided for 1500-2500 ms each, the next setfor 750-1500 ms each and the final set for 0-750 ms each. In all threesubsection levels, the duration between stimuli remains the same (1000ms in a preferred embodiment).

[0096] The next level of testing involves solving an arithmetic problem.The subject is told to solve the problem as quickly as possible, and topress the appropriate mouse button based on the answer to the arithmeticproblem. For the example described above, if the answer to the problemis 4 or less, the subject must press the left mouse button, while if theanswer to the problem is greater than 4, the subject must press theright mouse button. The arithmetic problem is a simple addition orsubtraction of single digits. As before, each set of stimuli is shownfor a certain amount of time at the first subsection level andsubsequently decreased (thus increasing speed of reaction time) at eachfurther level. In a preferred embodiment, three levels of speed areused, wherein the stimulus is shown for 1500-2500 ms, 750-1500 ms and0-750 ms respectively. A minimum of 10 stimuli is provided for eachlevel.

[0097] The third level of testing is similar to the second level, butwith a more complicated arithmetic problem. For example, two operatorsand three digits may be used. After each level of testing, accuracy isevaluated. If accuracy is less than 70% at any level, then that portionof the test is terminated. It may be readily understood that additionallevels are possible, both in terms of difficulty of the arithmeticproblem and in terms of speed of response.

[0098] It should be noted that the mathematical problems are design tobe simple and relatively uniform in the dimension of complexity. Thesimplicity is required so that the test scores are not highly influencedby general mathematical ability. The stimuli are also designed to be inlarge font, so that the test scores are not highly influenced by visualacuity. In addition, since each level also has various speeds, the testhas an automatic control for motor ability.

[0099] The system collects data regarding the response times, accuracyand level reached, and calculates scores based on the collected data.

[0100] E) VERBAL FUNCTION:

[0101] Verbal Naming and Rhyming Test

[0102] A verbal naming and rhyming test is provided to evaluate asubject's verbal function. It is made more difficult by the use ofsemantic foils, requiring an executive function (frontal lobes of thebrain) to suppress the natural tendency towards the semantic foil,favoring the phonological choice.

[0103] The first level is a practice/explanation level, in which thesystem explains (step 201) to the subject that the object of the test isto choose the word that rhymes with a picture shown on the screen.Examples of pictures with rhyming words are shown. Next, the systemdisplays a picture on the screen for a predetermined amount of time(1000 ms in a preferred embodiment), and two choices of words aredisplayed: one which rhymes with the picture and one which issemantically related to the picture. The subject must choose the wordthat rhymes as quickly as possible by pressing the corresponding numberon the number pad. Feedback is provided if the answer is incorrect. Ifaccuracy is ⅔ or higher, the test moves on to the next level. Otherwise,the practice session is repeated. If accuracy is still less than ⅔, thetest is terminated. Thresholds for terminating or continuing tests arevariable and are not limited to those described herein.

[0104] For the testing levels, the subject is asked to choose the wordthat rhymes, as in the practice session, but without feedback. Severallevels of testing may be performed, each of which is more difficult interms of the stimulus. The level of difficulty may be related to thesubject's familiarity with the name of the stimulus. It should be notedthat cultural and language differences are important for this test. Thistest may be available in various languages, and for different culturalgroups.

[0105] The system measures response time, accuracy, and level andcomputes a score based on the measured parameters.

[0106] Naming Test

[0107] The naming test is a subtest of the rhyming test, which servestwo purposes. First, it tests different verbal skills than the rhymingtest, and secondly, it is a control for cultural bias. Thus, a responsewhich was wrong both on the rhyming and on the naming test, would bediscounted for the rhyming test. In this way, a picture eitherunrecognized or referred to by a different name would not count in thefinal scoring. Preferably, the naming test is performed after the verbaltest so as not to interfere with the thought process involved infiguring out rhyming words versus related words. At each level, ifaccuracy is less than, for example, 70%, the test is terminated.

[0108] F) EXECUTIVE FUNCTION:

[0109] The following series of tests are designed to test higher brainfunction, such as reasoning, etc. Some of them have dual or triplepurposes as well, as will be described further hereinbelow.

[0110] Stroop Test

[0111] A stroop test is a well-known test designed to test higher brainfunctioning. In this type of test, a subject is required to distinguishbetween two aspects of a stimulus. In the stroop test described herein,the subject is shown words having the meaning of specific colors writtenin colors other than the ones indicated by the meaning of the words. Forexample, the word RED is written in blue. The subject is required todistinguish between the two aspects of the stimulus by selecting acolored box either according to the meaning of the word or according tothe color the word is written in. The additional parameter of speed ismeasured simultaneously.

[0112] The first part of the test is a practice session. The systemdisplays two colored boxes and asks the subject to select one of them,identifying it by color. Selection of the appropriate box may beaccomplished by clicking the right or left mouse button, or by any othersuitable method. The boxes remain visible until a selection is made.After responding, the system provides feedback if the incorrect answerwas chosen. The practice session is repeated several times. If theperformance is less than 80%, the practice session is repeated. If it isstill less than 80% after another trial, then the test is terminated.

[0113] Once the practice session is completed, the system presents arandom word written in a certain color. In addition, the system presentstwo boxes, one of which is the same color as the word. The subject isrequired to select the box corresponding to the color of the word. Nofeedback is given. This test is repeated several times, preferably 10.On the next level, the system presents the words “GREEN”, “BLUE” or“RED”, or another word representing a color. The word is presented inwhite font, and the system concurrently presents two boxes, one of whichis colored corresponding to the word. The subject is required to selectthe box corresponding to the color related to the meaning of the word.No feedback is given. This test is repeated several times, preferably 30times, or at least 2-3 times the number of samples as the first part. Inthis way, the subject gets used to this particular activity.

[0114] The next level is another practice session, in which the systempresents a color word written in a color other than the one representedby the meaning of the word. The subject is instructed to respond to thecolor in which the word is written. Because it is a practice session,there is feedback. The test is repeated several times, and if theperformance is not above a certain level, the test is terminated. If thesubject is successful in choosing the color that the word is written inrather than the color that represents the meaning of the word, the nextlevel is introduced.

[0115] The next level is the actual “stroop” test, in which the systemdisplays a color word written in a color other than the one representedby the word. The word is visible together with two options, one of whichrepresents the color the word is written is. The subject is required tochoose that option. This test is repeated numerous times (30 isoptimal), and there is no feedback given. Level, accuracy and responsetime are all collected and analyzed.

[0116] Go/NoGo Response Inhibition

[0117] A Go/No Go Response Inhibition test is provided in accordancewith one embodiment of the present invention. The purpose of the test isto evaluate concentration, attention span, and the ability to suppressinappropriate responses.

[0118] The first level is a practice session. The system displays acolored object, such as a box or some other shape. The object is asingle color, preferably red, white, blue or green. It should be notedthat by using a color as a stimulus, rather than a word such as is thecase in prior art tests of this type, the test is simplified. Thissimplification allows for subjects on many different functional levelsto be tested, and minimizes the effect of reading ability or vision. Thesubject is required to quickly select a mouse button for the presence ofa particular color or not press the button for a different color. Forexample, if the object is blue, white or green, the subject shouldquickly press the button, and if the object is red, the subject shouldrefrain from pressing the button. It should be readily apparent that anycombination of colors may be used.

[0119] The first level of the test is a practice session, wherein thesubject is asked to either react or withhold a reaction based on astimulus. Each stimulus remains visible for a predetermined amount oftime, and the subject is considered to be reactive if the response ismade before the stimulus is withdrawn. In a preferred embodiment, theobject remains visible for 400 ms. In a preferred embodiment, the systempresents two red objects and two different colored objects, one at atime, each for approximately 400 ms. The subject is asked to quicklypress any mouse button when any color other than red is displayed, andto not press any button when a red color is displayed. Feedback isprovided in between each of the trials to allow the user to know whetherhe/she is performing correctly. If the subject has at least ¾ correct,he/she moves on to the next level. Otherwise, he/she is given one morechance at a practice round, after which the test continues or isterminated, depending on the subject's performance.

[0120] There is only one testing level for this particular embodiment,in which the stimuli are similar to the ones given in the practicesession, but the subject is not provided with any feedback. Bothsensitivity and specificity are calculated.

[0121] Non-Verbal IQ Test

[0122] A Non-verbal IQ Test is provided in accordance with oneembodiment of the present invention. The purpose of the test is toevaluate non-verbal intelligence, particularly logic and reasoningskills. The subject is required to choose the best match of a setpattern, and the test has increasing levels of difficulty.

[0123] The first level of the test is a practice session, in which thesubject is shown one set of four picture words, with one picturemissing. Several choices appear, wherein one of the choices is themissing picture and the others are decoys specific to each test. Inlevel one, all four picture words are identical, and the correct picturesimply has to be chosen. Feedback is provided if the response isincorrect.

[0124] Reference is now made to FIG. 9, which shows a screen shot of anexample of a stimulus and a set of choices for the test describedherein, according to one embodiment. As shown in FIG. 9, three shapesare shown, and they form a particular pattern, with one form missing.The subject is required to choose the best match from the five choicesshown on the bottom of the screen. The subject has to use logic skillsin order to arrive at the correct answer. The levels of the sets becomeincreasingly more difficult. The accuracy, the level of testing and theresponse time are all measured and compiled into final scores.

[0125] Data Processing

[0126] Testing data are organized into an assessment report, which isthen sent to the clinician. Data are processed and compiled in a waywhich gives the clinician an overview of the results at a glance, whilesimultaneously including a large amount of information. Data areaccumulated and compiled from the various tests within a testingbattery, resulting in a composite score. A report showing results ofindividual parameters, as well as composite scores is then generated.

[0127] There are several levels of processing the data, as follows:

[0128] 1. Raw performance measures are generated for each test based onaccuracy, response time, level, or specific combinations of the measuredparameters. An accuracy score and a response time score are computed foreach trial. In one embodiment, accuracy is averaged for each level andis calculated as the total number of correct responses per total numberof trials. Response time may be measured by computing the time betweenwhen the stimulus appears and when the response occurs. An averageresponse time may be calculated for each level, averaging the reactiontimes for each trial. Variances and standard deviations may becalculated as well.

[0129] 2. For each level of difficulty (when applicable), a summary ofmean accuracy and mean and standard deviation of response times aregenerated.

[0130] 3. For certain tests, an aggregate accuracy score (compositescore) is generated. For tests where timing is critical, a derived indexis computed, by dividing accuracy by response time to account for the“speed-accuracy tradeoff.”

[0131] 4. Raw performance measures are converted into an IQ scale (basedon 100, plus or minus a standard deviation of 15) and are normalizedrelative to the performance of a population. Data relating to thepopulation are accumulated prior to testing based on a sample size of atleast 20 people, and are stored in a database which is easily accessibleby the system.

[0132] 5. Index scores are generated for each cognitive skill based onthe battery of tests. The index score is an arithmetic combination ofseveral selected normalized scores. For example, one index score maycontain within it a combination of various memory outcome measures. Thistype of score is more robust than a single measure since it is lessinfluenced by spurious performance on any individual test. For example,a memory index score may be comprised of individual measures from averbal and a non-verbal memory test, and may also include a delayedrecognition component. An example of an algorithm for computing theindex score, according to one preferred embodiment, is a linearcombination of a specific set of memory measures. The selection of themember of the set of measures and the weighting of each member is basedon the known statistical method of factor analysis. The resulting linearcombination is then converted to a memory index score by calculating aweighted average.

[0133] Index scores may be graphed in two ways. For example, a score formemory is calculated, for example, as 103. The first graph shows thescore as compared to the general population. The score of 103 is shownon the graph within the normal range for the general population. Thegeneral population may either be a random sampling of people, oralternatively, may be a selected group based on age, education,socio-economic level, or another factor deemed to be relevant. Thesecond graph shows the score as compared to any previous resultsobtained from the same battery of tests on the same subject. Thislongitudinal comparison allows the clinician to immediately see whetherthere has been an improvement or degradation in performance for eachparticular index.

[0134] 6. Global cognitive function scores are generated by combiningindividual matrixes. As shown on the graph, the global cognitivefunction score is also graphed relative to a population and relative toprevious results from the same individual.

[0135] Results may also be compared to a disease-specific metric. Forexample, if it is desired to determine whether an individual has normalmemory loss for their age or whether their memory loss is due to adisease such as Alzheimer's, an MCI (mild cognitive impairment) score iscalculated and compared to a normal population as well as adisease-specific population, immediately allowing the clinician to seewhat range the subject's performance fits into. Furthermore, severalindices may be compared, so as to determine which index is the mostsignificant, if any. Thus, the practitioner receives a complete pictureof the performance of the individual as compared to previous tests aswell as compared to the general population, and can immediately discernwhat type of medical intervention is indicated. It should also be notedthat at different points during the test itself, it may be determinedthat a specific test is not appropriate, and the tests will then beswitched for more appropriate ones. In those cases, only the relevantscores are used in the calculation.

[0136] Data reports may be sent to the clinician via any data transfermethod, such as the Internet. All data is encrypted according to knowntechniques before being sent through public domains, so that privacy isassured. A system for sending test batteries as well as assessmentreports or results data to a remote location is described in WO02/19889, assigned to a common assignee of the present application andincorporated herein by reference in its entirety.

What is claimed is:
 1. A system for cognitive testing, the systemcomprising: a battery of tests for measuring a neurological parameter;an interface allowing a clinician to access said battery of tests andadminister said battery of tests to a subject, said subject generatingdata in response to said administered battery of tests; a processor forprocessing said generated data; and a report generated by said processorand based on said generated data, wherein said report is available tothe clinician allowing the clinician to diagnose a medical condition andoptionally determine a treatment plan.
 2. The system of claim 1, whereinsaid neurological parameter is selected from the group consisting of:memory, attention, concentration, hand-eye coordination, informationprocessing speed, visual spatial perception, verbal ability, andexecutive function.
 3. The system of claim 1, wherein the interface is aweb-based interface, such as the Internet.
 4. The system of claim 1,wherein the battery of tests comprises at least one test having variouslevels of testing, the test comprising: an interface for providingstimuli to and collecting responses from said subject; a processor forprocessing said stimuli and said responses, the processor comprises: areceiver for receiving said responses and for providing feedback throughsaid interface; a calculator for calculating a performance parameterbased on said responses; a level determinator, for determining anoptimal level of testing based on said calculation, said optional levelof testing including introducing a new battery of tests; an automaticadjustor for adjusting said system to test at said determined level; anda scorer for determining scoring information based on said responses andsaid level adjustments; and a display, for displaying said scoringinformation.
 5. The system of claim 1, further comprising a database ofnormal and pathological normalized indices collected from selectedpopulations, wherein said generated data are compared to said normal andpathological normalized indices so as to determine the pathologicalstate of the subject.
 6. A system for evaluating a cognitive skill of asubject, the system having various levels of testing, the systemcomprising: an interface for providing stimuli to and collectingresponses from said subject; a processor for processing said stimuli andsaid responses, the processor comprises: a receiver for receiving saidresponses and for providing feedback through said interface; acalculator for calculating a performance parameter based on saidresponses; a level determinator, for determining an optimal level oftesting based on said calculation, said optional level of testingincluding introducing a new battery of tests; an automatic adjustor foradjusting said system to test at said determined level; and a scorer fordetermining scoring information based on said responses and said leveladjustments; and a display, for displaying said scoring information. 7.The system of claim 6, wherein said interface is a display monitor. 8.The system of claim 6, wherein said processor is a computer based chip.9. The system of claim 6, wherein said display is an assessment report.10. A diagnostic tool for determining a pathological state of a subject,the diagnostic tool comprising: a testing system for providing stimuliand receiving responses from the subject; a processor for processingsaid responses into normalized subject indices for selected cognitiveskills; and a database of normal and pathological normalized indicescollected from selected populations, wherein said normalized subjectindices are compared to said normal and pathological normalized indicesso as to determine the pathological state of the subject.
 11. Thediagnostic tool of claim 10, wherein said pathological state isdementia.
 12. The diagnostic tool of claim 11, wherein said pathologicalstate is Alzheimer's disease.
 13. The diagnostic tool of claim 10,wherein said cognitive skills are selected from the group consisting ofmemory, attention, concentration, hand-eye coordination, informationprocessing speed, visual spatial perception, verbal ability, andexecutive function.
 14. A computer-based testing system, said systemcomprising: a stimulus for evoking a response from a tested subject,said stimulus being relatively large so as to enable a mildly visuallyimpaired individual to see the stimulus; and an interface for respondingto said stimulus, said interface requiring minimal mental, visual, andmotor ability.
 15. The system of claim 14, wherein said stimulus is aword.
 16. The system of claim 14, wherein said stimulus is a shape. 17.The system of claim 14, wherein the interface is a keyboard.
 18. Thesystem of claim 14, wherein the interface is a mouse.
 19. The system ofclaim 14, wherein the interface is a joystick.
 20. A method forcognitive testing, the method comprising: retrieving a battery of teststhrough an interface; administering said battery of tests to a subject;collecting data from the subject in response to said battery of tests;processing said collected data so as to generate a report; accessingsaid report; and providing a diagnosis based on said report.
 21. Themethod of claim 20, wherein said retrieving and said accessing are doneover the Internet.
 22. The method of claim 20, wherein said processingcomprises: providing a first performance measure from a first test, saidproviding comprises: measuring a first parameter based on responses tosaid first test; measuring a second parameter based on responses to saidfirst test; combining said first and second parameters to produce a rawperformance measure; and normalizing said raw performance measurerelative to a known scale; providing a second performance measure from asecond test wherein said second test is designed to measure a similarcognitive skill as said first test, said providing comprises: measuringa first parameter based on responses to said second test; measuring asecond parameter based on responses to said second test; combining saidfirst and second parameters to produce a raw performance measure; andnormalizing said raw performance measure relative to a known scale; andcombining said first performance measure and said second performancemeasure so as to provide an index score, said index score.
 23. Themethod of claim 20, wherein said providing is done by comparing saidcollected data to data stored in a database.
 24. A method for evaluatinga cognitive skill of a subject, the method comprising: familiarizing thesubject with a testing system, said familiarizing comprises: providing astimulus to the subject; receiving a response to said stimulus from saidsubject; determining accuracy of said response; and providinginformation about said accuracy to the subject; providing dynamicallyadjustable stimuli from said testing system to the subject; receivingtesting responses to said stimuli; and evaluating said testingresponses.
 25. The method of claim 24, further comprising: using saidresponses to determine appropriateness of said testing system for saidsubject.
 26. The method of claim 24, wherein said determining accuracyincludes determining correctness.
 27. The method of claim 24, whereinsaid determining accuracy includes determining timing.
 28. A method fordistinguishing between normal and pathological aging, the methodcomprising: providing a battery of tests wherein responses to stimuliare collected; compiling an index score based on said collectedresponses; and comparing said index score to a performance database. 29.The method of claim 28, further comprising: providing a second batteryof tests wherein responses to stimuli are collected; and compiling asecond index score based on said collected responses; compiling acomposite score based on said index score and said second index score.30. The method of claim 28, wherein said index score is a memory score.31. The method of claim 28, wherein said index score is presented to aclinician as a report.
 32. A method for providing an index score to aclinician, the method comprising: providing a first performance measurefrom a first test, said providing comprises: measuring a first parameterbased on responses to said first test; measuring a second parameterbased on responses to said first test; combining said first and secondparameters to produce a raw performance measure; and normalizing saidraw performance measure relative to a known scale; providing a secondperformance measure from a second test wherein said second test isdesigned to measure a similar cognitive skill as said first test, saidproviding comprises: measuring a first parameter based on responses tosaid second test; measuring a second parameter based on responses tosaid second test; combining said first and second parameters to producea raw performance measure; and normalizing said raw performance measurerelative to a known scale; and combining said first performance measureand said second performance measure so as to provide an index score. 33.The method of claim 32, further comprising: providing a second indexscore; and combining said first and second index scores so as to providea composite score.
 34. A method for providing a diagnostic report to aclinician, the method comprising: obtaining an index score for acognitive skill; graphing said index score in relation to a database ofindex scores from a population; graphing said index score in relation topreviously obtained index scores from the subject; and presenting thegraphed index scores in a report format to the clinician.